Factors predicting infective complications following percutaneous nephrolithotomy and retrograde intrarenal surgery according to systemic inflammatory response syndrome and quick sequential organ failure assessment: A prospective study.

Purpose: Myriad operative factors and characteristics of patients may influence the risk of infection in a patient undergoing stone surgery. We prospectively determined the risk factors for systemic inflammatory response syndrome (SIRS) and quick sequential organ failure assessment (qSOFA) in patients undergoing percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS). Materials and Methods: Patients who underwent PCNL and RIRS from March 2018 to January 2020 satisfying our selection criteria were enrolled. Samples of urine from the renal pelvis, bladder, and retrieved stones were sent for culture testing. Postoperatively patients were keenly supervised for any indications of SIRS and qSOFA. The association between stone and urine cultures across various sites was examined. Regression analysis was performed to ascertain clinical variables affiliated with SIRS and qSOFA. Results: The study included a total of 150 patients including both PCNL and RIRS, of which 23% post-PCNL and 20% post-RIRS met the criteria of SIRS and qSOFA. On univariate analysis in PCNL-Dilated pelvicalyceal system (PCS), renal pelvic urine culture (RPUC), stone culture (SC), and operative time >124 min among others were identified as risk factors whereas, in RIRS-residual calculus, RPUC, SC and operative time >62 min were risk factors. Multivariate analysis identified dilated PCS and SC for PCNL and only intraoperative RPUC for RIRS as independent risk factors. Only a significantly strong correlation among culture analysis was found between RPUC and SC in both the procedures. Conclusion: Intraoperative RPUC and SCs are better predictors of post-PCNL SIRS while Intraoperative RPUC and duration of surgery are better predictors of post-RIRS sepsis. We, therefore, recommend that both these cultures must routinely be obtained in the above procedures to identify the offending organisms and amend antibiotic therapy during treatment and surgical duration should be kept <62 min in RIRS. SIRS serves as a sensitive review tool which is specifically useful for initial care and on the contrary qSOFA is well suited for patients at greater risk of demise, thereby guiding clinicians to decide future care and course of treatment of patients.

Ondansetron-induced QT prolongation among various age groups: a systematic review and meta-analysis.

BACKGROUND: Ondansetron is a selective 5-hydroxytryptamine type 3 serotonin-receptor antagonist with antiemetic properties used inadvertently in the emergency department for controlling nausea. However, ondansetron is linked with a number of adverse effects, including prolongation of the QT interval. Therefore, the purpose of this meta-analysis was to assess the occurrence of QT prolongation in pediatric, adult, and elderly patients receiving oral or intravenously administered ondansetron. METHODS: A thorough electronic search was conducted on PubMed (Medline) and Cochrane Library from the databases' inception to August 10, 2022. Only those studies were considered in which ondansetron was administered orally or intravenously to participants for the treatment of nausea and vomiting. The prevalence of QT prolongation in multiple predefined age groups was the outcome variable. Analyses were conducted using Review manager 5.4 (Cochrane collaboration, 2020). RESULTS: A total of 10 studies involving 687 ondansetron group participants were statistically analyzed. The administration of ondansetron was associated with a statistically significant prevalence of QT prolongation in all age groups. An age-wise subgroup analysis was conducted which revealed that the prevalence of QT prolongation among participants younger than 18 years was not statistically significant, whereas it was statistically significant among participants aged 18-50 years and among patients older than 50 years. CONCLUSIONS: The present meta-analysis provides further evidence that oral or intravenous administration of Ondansetron may lead to QT prolongation, particularly among patients older than 18 years of age.

Study of ureteral and renal morphometry on the outcome of ureterorenoscopic lithotripsy: The critical role of maximum ureteral wall thickness at the site of ureteral stone impaction.

PURPOSE: The purpose is to study the association of stone, ureteral, and renal morphometric parameters with the relevant outcome variables, i.e., complication rate, stone-free rate (SFR), and operating time of ureterorenoscopic lithotripsy. Although a safe procedure, it still occasionally has major complications. Computed tomography (CT) scan is often performed to diagnose ureteral calculi, providing opportunities for ureteral morphometry that may have a bearing on the outcome of the procedure. MATERIALS AND METHODS: Ureteric, renal, and stone morphometric parameters were measured from CT of the abdomen and pelvis of the 110 patients with ureteral calculi who underwent ureteroscopic lithotripsy (URSL). Data were collected retrospectively in 25 patients and prospectively in 85 patients. Association of these parameters with the outcome variables of the procedure mentioned above was studied. RESULTS: On univariate analysis, body mass index, stone size, and maximum ureteral wall thickness (MUWT) were found to have a significant association with URSL complications, SFR, and duration of surgery. On multivariable analysis, only MUWT was found to be an independent risk factor for URSL complications. In 90% of total patients with residual stones, MUWT was found to be >4.8 mm. CONCLUSION: Ureteral wall thickness of >4.8 mm is associated with prolonged duration of surgery and lower SFR. Patients with ureteral wall thickness of >4.8 mm at the site of ureteral stone who are planned for URSL must be counseled about the higher chances of residual stones and the need for additional procedure.

Testicular and Epididymal Metastasis from Prostate Carcinoma: A Rare Manifestation of Common Disease.

Carcinoma prostate secondary metastasis to testicle and epididymis is rare. We report a case of metastatic carcinoma prostate in which testicular and epididymal metastasis were diagnosed incidentally in bilateral orchiectomy specimen. Testicular and para testicular structure should be properly evaluated for accurate staging of carcinoma prostate. Epididymis should always be included in bilateral orchidectomy specimen.

Recurrent Malignant Pheochromocytoma with Lymph Nodal Metastasis in a Child: A Rare Case.

Malignant pheochromocytoma in children manifesting as local recurrence with multiple lymph nodal metastasis is a rare entity. We report a case of a 14-year-old child with recurrent sporadic malignant pheochromocytoma presenting 8 years after primary surgery with retroperitoneal lymphadenopathy. The child underwent excision of the tumor along with retroperitoneal lymphadenectomy. Histopathology confirmed pheochromocytoma with extensive lymph node metastasis. The patient has no signs of disease recurrence till date. This report supports the long-term follow-up and aggressive surgical approach to remove all foci of tumor in recurrent pheochromocytoma.

Bellini Duct Carcinoma: A Rare Entity.

Bellini duct carcinoma of kidney derives from collecting duct and is associated with an aggressive course and extremely poor prognosis. Here, we report an interesting case of Collecting Duct Carcinoma (CDC) with Inferior Vena Cava (IVC) thrombus and large retroperitoneal lymph nodes and diffuse desmoplastic reaction. The patient underwent left open radical nephrectomy with IVC thrombectomy and regional lymphadenectomy. Based on morphological and immunohistochemical analysis, diagnosis of collecting duct (Bellini duct) carcinoma was made. Presently, patient is on adjuvant chemotherapy with gemcitabine and cisplatin and under follow-up.

Endoscopic Combined Intrarenal Surgery for Simultaneous Renal and Ureteral Stones: A Retrospective Study.

PURPOSE: The management of simultaneous renal and ureteral calculi usually require staged procedure or change of position from supine lithotomy for ureterorenoscopic lithotripsy to prone for conventional percutaneous nephrolithotomy (PCNL). We review our experience with endoscopic combined intrarenal surgery (ECIRS) in the management of this condition. MATERIALS AND METHODS: A total of 43 patients with simultaneous renal and ureteral calculi underwent ECIRS in Galdakao-modified supine Valdivia (GMSV) position from June 2012 to March 2016. Relevant demographic and clinical data were analyzed retrospectively. Clinical outcomes such as stone-free rate, complications, and hospital stay were evaluated. Factors predicting stone-free rate were also evaluated. RESULTS: The mean ureteral stone size was 9.79 ± 2.11 mm and the mean renal stone size was 28.0 ± 11.4 mm. All patients with ureteral calculus were stone free after first intervention. The overall immediate renal stone success rate was 81.4%, which increased to 97% after auxiliary procedure. The overall complication rate was 32.5% with majority of complications (86%) classified under Clavien grade 1 and 2. Two patients had Clavien grade 3 complication with no grade 4 or 5 complications. The mean operative room occupation time was 132.09 ± 35.3 minutes. The median hospital stay was 6 days (range: 2-31). On analyzing for risk factors, only the number of involved calices by stone was significantly associated with stone-free rate following ECIRS (p = 0.03). CONCLUSION: ECIRS is a novel and excellent approach for the treatment of simultaneous renal and ureteral calculi with stone clearance and morbidity profile comparable to traditional prone PCNL. We believe that the advantage provided by this approach to the surgeon, patient, and anesthetist may lead to widespread adaptability of this technique in the management of complex urolithiasis.